Scenario D

Disaster has struck - hard on the heels of the COVID-19 pandemic, another disease outbreak has hit your fair city, Rosblane. Residents are outraged and worried. There have already been 13 deaths.

The cause of the outbreak appears to be Campylobacter jejuni. (Please refer to the WHO Campylobacter Fact Sheet for more information about the pathogen.)

Scanning electron microscopy (SEM) image of Campylobacter jejuni cells. Image credit: [CDC](https://phil.cdc.gov/Details.aspx?pid=5778)

Figure 1: Scanning electron microscopy (SEM) image of Campylobacter jejuni cells. Image credit: CDC

Each member of your group will play one of the following roles as you attempt to tackle the disease outbreak and save your city:

  1. Provost (head of the city council)
  2. Representative from a national public health org. (Public Health Scotland)
  3. Epidemiologist (on secondment from Public Health Scotland)
  4. Director of the city’s main hospital (North Shore)
  5. City planner/civil servant
  6. Microbiologist (working in one of the NHS Scotland clinical labs)
  7. Public communications expert (past and current sci comm campaigns)
  8. Doctor at a major surgery in Rosblane

You must work together, using the information that has been provided for you in the attached information packets, and decide what action(s) should be taken to control the measles outbreak currently plaguing your city, Rosblane. Your actions should be evidence-based – use the peer-reviewed literature to decide on measures that will stop the pandemic in your scenario.

Your action points may include directives to gather more information (e.g., contact tracing of current cases, microbiological testing of food/water, etc.), or specific directives (e.g. public health measures, non-pharmaceutical interventions, etc.). Use the data/expertise of all group members. Be clear, concise, and specific.

You should submit 3-5 specific actions to control the pandemic, using the workshop 3 pro forma (available on MyPlace). Submit this by noon, Friday March 10th, via the submission link on MyPlace.

Information Packet D1

You are the provost of Rosblane, elected in 2020.

Photograph of Rosblane city centre. Image credit: DALL-E

Figure 2: Photograph of Rosblane city centre. Image credit: DALL-E

The current population of Rosblane (as of December 2022) is 157946. The demographic data for the city is shown below.

Rosblane demographics (Source: Office for National Statistics)Rosblane demographics (Source: Office for National Statistics)

Figure 3: Rosblane demographics (Source: Office for National Statistics)

You were elected as a member of the popular “PARTY3” party and made a number of election promises regarding a “Green New Deal” for Rosblane.

Voting intention by Rosblane residents (Source: YouGov polling)

Figure 4: Voting intention by Rosblane residents (Source: YouGov polling)

There are currently 41 elected councillors, representing the 5 main political parties in Rosblane as follows:

Political Party Number of Seats
PARTY1 2
PARTY2 10
PARTY3 19
PARTY4 8
PARTY5 2



The overall budget (expenditures) for the 2021-2022 financial year is £447466265. A summary of expeditures by category for this financial year is shown below.

Public expenditures by category for the 2021-2022 financial year (Source: Rosblane City Council)

Figure 5: Public expenditures by category for the 2021-2022 financial year (Source: Rosblane City Council)

Your office has recently received a great deal of correspondence regarding the pandemic in Rosblane. A representative sample of these e-mails is shown below.

From:
To:
Cc: Subject: This Horrible Pandemic

Dear Provost,

I am outraged to hear about this new pandemic in Rosblane. As if COVID wasn’t enough! Has this city not suffered enough, I ask you.

I sincerely hope that your office is going to do something about dreadful state of affairs immediately.

Yours sincerely,
Roman

From:
To:
Cc:
Subject: Pandemic Disaster for Businesses

Dear Provost,

This new pandemic in Rosblane has the potential to obliterate our businesses. I run a restaurant on the high street and nearly went bankrupt due to COVID.

I hope you realise how costly the last pandemic was for millions of people across the country, and that we can’t afford another one.

I expect that your office is going to do something about tragedy immediately, keeping in mind the economic interests of businesses in our city and the fact that we cannot afford restrictions that cripple our businesses.

Sincerely,
Gordon (Fraser & Co., proprietor)

From:
To:
Cc:
Subject: Stop This Madness

Dear Provost,

I hate the idea that you and your office are going to use this new pandemic as yet another excuse for government overreach into citizens’ lives. This last pandemic was just a typical example of what governments do when given a little too much power.

Facemasks are just the tyranny of the minority over the majority, I hope that you will not permit them again on your watch.

Respectfully,
Siobhan (a concerned voter)

From:
To:
Cc:
Subject:

Dear Provost,

I have just learned that my my nana’s best friend has passed away due to the new pandemic in Rosblane. You cannot begin to imagine the grief that we are feeling.

The family are all devastated as you can surely imagine.

I don’t understand why we haven’t learned how to deal with pandemics better, after all our experiences with COVID-19, I don’t understand how this could have happened.

Yours truly,
Graham

As Provost of Rosblane, you are of course familiar with the work of the Standing Committee on Pandemic Preparedness, the UK Pandemic Preparedness plan, and the latest COVID-19 health protection guidance released by Public Health Scotland.

Information Packet D2

You are a representative from Public Health Scotland, sent to Rosblane to help with the Campylobacter jejuni outbreak.

Your briefing packet includes the following documents:

name or paper citation - x4 total

Information Packet D3

You are an epidemiologist working for Public Health Scotland, sent to Rosblane to help with the measles outbreak.

REPLACE THIS TEXT and TABLE - A team of scientists working together have in a PHS lab have isolated and cultured Campylobacter jejuni virus (using a standard tissue culture model) from a number of patient samples taken during this outbreak; isolated Campylobacter jejuni RNA from these cultures; reverse-transcribed this to DNA and sequenced this DNA using an Illumina MiSeq platform; assembled the short paired-end reads; and compared these assemblies to the extant Campylobacter jejuni sequences available in the NCBI databases. The results of these experiments are summarised in the table below.

Patient NCBI accession of closest database match
1 acc.no.here
2 acc.no.here
3 acc.no.here
4 acc.no.here
5 acc.no.here
6 acc.no.here
7 acc.no.here
8 acc.no.here
9 acc.no.here
10 acc.no.here



Your briefing packet also includes the following documents:

text x1, citation x1

Information Packet D4

You are the director of Rosblane’s main hospital, the North Shore, which has 550 beds across 9 different wards and 10 operating theatres.

The North Shore hospital in Rosblane. Image credit: [DALL-E

Figure 6: The North Shore hospital in Rosblane. Image credit: [DALL-E

The annual operating budget for financial year 2021-2022 was £1.5 million, and average expenditures are shown by category in the figure below.

Hospital expenditures by category for financial year 2021-2022 (Source: NHS Scotland)

Figure 7: Hospital expenditures by category for financial year 2021-2022 (Source: NHS Scotland)

The North Shore has units specialising in coronary care; maternity care; dermatology; gastroenterology; an ear, nose, and throat clinic; an eye clinic; and an orthopedic unit.

There are currently 25 ICU beds (with ventilators) available, an increase from the 14 ICU beds in the North Shore in November 2019. Average ICU bed occupancy before and during the COVID-19 pandemic is in the figure below.

ICU bed occupancy for the Rosblane North Shore hospital (Source: NHS Scotland)

Figure 8: ICU bed occupancy for the Rosblane North Shore hospital (Source: NHS Scotland)

There are approximately 1.3m admissions to the North Shore hospital annually, the majority of these being to the emergency (A&E) department.

Admissions to the Rosblane North Shore hospital by category (Source: NHS Scotland)

Figure 9: Admissions to the Rosblane North Shore hospital by category (Source: NHS Scotland)

A&E waiting times have been called “disastrously high” in recent months, both by the press and by tthe hospital ombudsman.

ICU waiting times for the Rosblane North Shore hospital (Source: NHS Scotland)

Figure 10: ICU waiting times for the Rosblane North Shore hospital (Source: NHS Scotland)

The North Shore has been set a goal of 25% reduction in sepsis mortality (compared to past years)and 50% reduction in the nosocomial transmission of superbugs such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridiodes difficile (C. diff), and Candida auris (C. auris).

Key Performance Indicators (KPIs) related to infectious diseases for the Rosblane North Shore hospital (Source: NHS Scotland)

Figure 11: Key Performance Indicators (KPIs) related to infectious diseases for the Rosblane North Shore hospital (Source: NHS Scotland)

There are currently 165 patients in the North Shore with confirmed or suspected Campylobacter jejuni, with 15 of these patients currently in the ICU.

Information Packet D5

You are a civil servant working in Rosblane, working closely with the provost, city council and various agencies including the NHS, the UK Health Security Agency (UKHSA), and the Scottish Environment Protection Agency (SEPA).

Some of the key Rosblane facts and figures at a glance are summarized in the table below.

Community Amenities Details
Schools 3 primary schools, 4 secondary schools, 1 college
Care Homes 4, each with ~40 bed capacity
Restaurants and Cafes 129
Parks and Playgrounds 6
Economic Indicators Details
GDP/capita £39105
Unemployment Rate 4%
Traffic and Transport Details
Traffic fatalities (average/month) 13



Your briefing packet on Campylobacter jejuni includes the following information.

text x4

Information Packet D6

You are a microbiologist working in the microbiology department at the Greater Rosblane Clinical Laboratory. Your laboratory is equipped to handle a range of culture samples (including anaerobic and microaerobic bacteria, as well as viruses), and you routinely process1624 samples monthly.

You are familiar with the culture requirements for growth of Campylobacter, and the range of UK Standards for Microbiology Investigations (UK SMI) for Identification of Campylobacter species.

Campylobacter jejuni grown on Skirrow and Butzler growth medium. Image credit: [CDC](https://phil.cdc.gov/Details.aspx?pid=15986)

Figure 12: Campylobacter jejuni grown on Skirrow and Butzler growth medium. Image credit: CDC

3x citations or links

Information Packet D7

You are a public communications expert, often employed by the Rosblane city council to manage the PR response to different initiatives or crises. You have assembled the following information/resources for this meeting:

3x citations or links

Information Packet D8

You are one of the doctors at the largest surgery in Rosblane. In the past fortnight, 62 of your patients have recently presented to the surgery with symptoms consistent with Campylobacter jejuni. You have therefore recently been familiarising yourself with the relevant literature:

text x4

citations x3